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Smoking and Death in India

World Bank seminar, April 2, 2008, Washington, DC. Smoking and Death in India. Prabhat Jha On behalf of the RGI-CGHR Investigators Sources of support: ICMR and RGI (India); FIC, NIH (US); IDRC & CIHR (Canada); CTSU, MRC & CR-UK (UK) Centre for Global Health Research (CGHR)

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Smoking and Death in India

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  1. World Bank seminar, April 2, 2008, Washington, DC Smoking and Death in India Prabhat Jha On behalf of the RGI-CGHR Investigators Sources of support: ICMR and RGI (India); FIC, NIH (US); IDRC & CIHR (Canada); CTSU, MRC & CR-UK (UK) Centre for Global Health Research (CGHR) Keenan Research Centre at the Li Ka Shing Knowledge Institute St. Michael’s Hospital, University of Toronto prabhat.jha@utoronto.ca

  2. Key messages for the individual smoker in India • Risk BIGGER than previously thought • Smoking kills EARLY: 70% smoking deaths are at ages 30-69, losing decades of good life • Even a FEW bidis or cigarettes per day kills • STOPPING SMOKING WORKS – but, less than 2% of adults in India have quit

  3. Nationally representative sample (Sample Registration System) • 6,671 of these small areas randomly chosen from all parts of India (each with about 1000 people per area)

  4. How was the study done? 900 non-medical staff monitored 1.1 M (11 lakh) homes for three years (2001-3) 2 physicians assigned underlying fatal disease (eg TB) All adult deaths from diseases (74,000 deaths) Obtain smoking history of the dead from living household members Compare smoking history of the dead to smoking history of 78,000 living adults

  5. What’s new about this research? • Large size of study • Nationally representative study of the causes of deaths in adults: results reflect the whole of India • First reliable study of female deaths from smoking in India

  6. Smoking prevalence in India Cigarette or bidi (less tobacco than a cigarette, wrapped in the leaf of another plant)

  7. Rising prevalence among young men?

  8. Smoking prevalence by education

  9. Smoking prevalence by education

  10. Indian Women aged 30-69No. of deaths studied and smoker vs nonsmoker death rate ratio (RR) *versus 4.5% of 26,678 living women who had smoked † Risk ratio adjusted for age, alcohol use and education

  11. Indian Men aged 30-69No. of deaths studied and smoker vs nonsmoker death rate ratio (RR) *versus 37.0% of 31,661 living men who had smoked † Risk ratio adjusted for age, alcohol use and education

  12. Smoking kills all categories of men results for men aged 30-69 Smoker vs Nonsmoker Risk Ratio *adjusted for age, alcohol use and education

  13. Any smoking kills *adjusted for age, alcohol use and education

  14. Cumulative risk of death, from age 30smokers vs nonsmokers Women *adjusted for age, alcohol use and education

  15. Cumulative risk of death, from age 30smokers vs nonsmokers Men *adjusted for age, alcohol use and education

  16. Disease-specific risks of death, ages 30-69smokers vs nonsmokers * Women *risk in the absence of other causes of death, adjusted for age, alcohol use and education

  17. Disease-specific risks of death, ages 30-69smokers vs nonsmokers * Men *risk in the absence of other causes of death, adjusted for age, alcohol use and education

  18. Deaths from smoking in year 2010 in India, ages 30-69, by disease

  19. Deaths from smoking in year 2010 in India Annual deaths from smoking will rise from 930,000 to 1,000,000 (10 lakh) during 2010s

  20. Low quit rates in India, 2004 *highest and + lowest male quit rates, respectively

  21. INDIA: 1 million (10 lakh) smoking deaths per year during 2010s • Smoking causes 10% of the 10 million (1 crore) deaths per year from all fatal disease • 70% of smoking deaths are in middle age (30-69): 700,000 (7 lakh); 600,000 men and 100,000 women • 20% of all adult male deaths and 5% of all adult female deaths in middle age • Over 50% of smoking deaths are in illiterate adults

  22. Key messages for the individual smoker in India • Risk BIGGER than previously thought • Smoking kills EARLY: 70% smoking deaths are at ages 30-69, losing decades of good life • Even a FEW bidis or cigarettes per day kills • STOPPING SMOKING WORKS – but, less than 2% of adults in India have quit

  23. Press materials on: www.cghr.org/tobacco • NEJM Paper and Supplementary Appendix • Press and video releases: English, Hindi and regional languages • Frequently-asked questions • PowerPoint slides in English • Information about CGHR and partners News coverage of paper at: http://youtube.com/watch?v=9COgO6cXwY4http://youtube.com/watch?v=uH66GQADiEs

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